Harada Tatsunosuke, Numata Masakatsu, Atsumi Yosuke, Fukuda Toshiyuki, Izukawa Shota, Suwa Yusuke, Watanabe Jun, Sato Tsutomu, Saito Aya
Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan.
Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan.
Surg Today. 2025 Jan 11. doi: 10.1007/s00595-024-02988-7.
In recent years, major advancements have been made in rectal cancer surgery with the introduction of new techniques such as robotic surgery and indocyanine green fluorescence imaging (ICG-FI). This study aimed to evaluate the comprehensive risk factors for anastomotic leakage (AL) following rectal cancer surgery, incorporating recently introduced techniques and other existing factors, to reflect current practices.
A retrospective analysis was conducted of 304 patients who underwent either robotic or laparoscopic anterior resection between January 2019 and December 2023. The study analyzed patient, tumor, and surgical factors, with AL defined by clinical or radiological findings requiring intervention within 30 days after surgery.
A univariate analysis indicated that moderate or severe anemia and the non-use of ICG-FI were strongly associated with AL. A multivariate analysis identified moderate or more severe anemia (hemoglobin ≤10.9 g/dL for males and ≤9.9 g/dL for females) (odds ratio [OR]: 9.94, p = 0.002) and non-use of ICG-FI (OR: 10.40, p < 0.001) as independent risk factors for AL.
Moderate or severe anemia and absence of ICG-FI were found to significantly increase the risk of AL. Preoperative anemia correction and the routine use of ICG-FI may help mitigate this risk, thus suggesting the need for further research in these areas.
近年来，随着机器人手术和吲哚菁绿荧光成像（ICG-FI）等新技术的引入，直肠癌手术取得了重大进展。本研究旨在评估直肠癌手术后吻合口漏（AL）的综合危险因素，纳入最近引入的技术和其他现有因素，以反映当前的实践情况。
对2019年1月至2023年12月期间接受机器人或腹腔镜前切除术的304例患者进行回顾性分析。该研究分析了患者、肿瘤和手术因素，AL由术后30天内需要干预的临床或影像学检查结果定义。
单因素分析表明，中度或重度贫血以及未使用ICG-FI与AL密切相关。多因素分析确定中度或更严重贫血（男性血红蛋白≤10.9 g/dL，女性血红蛋白≤9.9 g/dL）（比值比[OR]：9.94，p = 0.002）和未使用ICG-FI（OR：10.40，p < 0.001）是AL的独立危险因素。
发现中度或重度贫血以及未使用ICG-FI会显著增加AL的风险。术前纠正贫血和常规使用ICG-FI可能有助于降低这种风险，因此表明需要在这些领域进行进一步研究。
